What is Happening in Healthcare Settings Today?

As you may have experienced yourself, most of the hospitals and
clinics built in the 20th century were not designed for the healing of
patients and comfort of family. Consider, for example, how the focus of
many hospital rooms is the somewhat frightening medical equipment,
while the halls throughout are painted in practical, but depressing
hospital green with noisy, but easy-to-clean linoleum floors.

Some
people have even compared these settings to prison: an institutional
environment with few concessions to aesthetics, where furthermore,
personal clothes and effects are taken away and the inmate/patient has
few choices about what happens. It is often a dehumanizing environment
that runs counter to healing.

However,
this is beginning to change as healthcare moves towards a more
patient-centered and holistic model.

Moreover, evidence points to the
real benefits of healthcare facilities designed around patient, family,
and staff needs and preferences.These benefits not only improve
patient outcomes and increase staff effectiveness and morale, they also
help administrators meet key safety goals, reduce costs, and increase
market share. They include:

The Institute of Medicine[9]
(IOM) has published a number of reports that stress the importance of
improving quality and safety in healthcare settings. Research
demonstrates that design that is patient-, family-, and staff-focused
does much to meet IOM goals and improve quality and safety.

What else is driving the change?

Currently
many hospitals and other healthcare facilities, such as long-term care
facilities are being constructed to replace those at the end of their
life and to meet the demand as the baby boomer population grows older.
Many of these are designed according to a new understanding of the
healing environment[10] and the research behind evidence-based design.

Clinics
are also beginning to change, not least because the American healthcare
system can no longer afford a system that focuses on disease-based
care. Healthcare is beginning to recognize the central place that
wellbeing[11] of mind, body, and spirit plays in health.

Springing
from this, clinics are realizing that a healing environment can
contribute greatly to the wellbeing of patients coming in for
procedures or to manage a chronic disease.

In addition, as
healthcare consumers become more aware of their choices, healthcare
organizations hope to attract their business with a welcoming
environment. The physical setting is the patient's first impression of
a healthcare facility and one of the most important factors in the
patient's perceptions of the quality of care and their overall
satisfaction.

Two leading organizations driving change

The Center for Health Design[12] is
a non-profit research organization that advocates for change in
healthcare design. Its mission is to "transform healthcare settings
into healing environments that improve outcomes through the creative
use of evidence-based design."

The Center summarized the
available research in this area in its 2004 publication, The Role of
the Physical Environment in the Hospital of the 21st Century, which
suggests that evidence-based design positively impacts the following
factors in healthcare organizations:

Patient-related outcomes

Staff satisfaction

Quality

Safety

Operational efficiency

Financial performance

The
Center created an agenda for research in this area, out of which grew
the Pebble Project, so called because the research conducted in
individual hospitals has a ripple effect throughout the healthcare
industry as results show important benefits.

Planetree[13]
was started by a patient after her less-than-positive experience in a
hospital, and it has had a major influence in moving patient-centered
care into the mainstream of healthcare today. The organization has
created a model for patient-centered care that lists nine elements:

Design healing environments (architecture and design that contribute to health)

The
Planetree research shows these changes result in an increase in patient
satisfaction and decrease in patient length of stay. They also result
in increased staff retention and ability to recruit new staff.

What changes are happening in the physical environment?

One of the biggest trends in new hospital construction and renovations is the move to single rooms.
There are many reasons for a hospital to move exclusively to single
rooms, not the least is the greatly reduced risk of infection. Single
rooms remove the roommate as a source of infection and are easier to
clean. In addition, some evidence indicates that staff wash hands more
often in single rooms.

Single rooms also offer:

More
privacy (imagine sharing the most private things in life with a total
stranger three feet away at a time when you are most vulnerable)

Better communication with caregivers who can talk more freely without worrying about betraying confidentiality

More social support[15] because friends and family can visit more and even stay overnight with you

The evidence for the benefit of single rooms is strong, so if you have any choice in the matter, get a single room.

Below is a list of other trends in new and renovated hospitals and the reasons behind them:

Acuity adaptable rooms,
which allow a patient to stay in the same place throughout their
hospital stay-from their admission as a critical care patient to their
release-instead of transferring rooms multiple times. This reduces
medical errors significantly and enables the development of healing
relationships because patients in theory have the same nursing staff
during their entire stay. It also reduces the uncertainty and
discomfort of moving and helps friends and family become comfortable
with the space and facilities.

Positive distractions,
such as nature and artwork. Many facilities are now adding indoor
gardens, aquariums, and landscapes to bring nature into the
environment. Extensive research demonstrates that even a short exposure
to nature reduces patient stress considerably. Artwork is also a
therapeutic distraction. Research shows that natural scenes are
restorative, and are most liked when they have a depth perspective and
an element of mystery. On the other hand, ambiguous and abstract art
can be frightening, especially when people are ill.

Natural light and control over lighting.
Research indicates that patients in rooms that receive more sunlight
may be less depressed and have shorter stays. In addition to natural
light, a trend is to offer softer ambient lighting with specific
lighting sources for staff tasks and for patient control of lighting
levels.

Noise reduction strategies to
reduce the environment stress that noisy hospitals produce. Hospitals
are attempting to both reduce the noise sources (for example by
reducing or eliminating overhead paging) and to improve sound proofing
with sound-absorbing ceilings and carpeting. Carpet alone can reduce
ambient noise by up to 70% (Leibrock).

Features to improve staff effectiveness.
For example, decentralized nursing stations place nurses closer to
patients, so they spend less time walking, have more time with
patients, and are better able to observe patients at all times, which
is proven to reduce patient falls. Another example is more organized,
better lit medication rooms with fewer distractions, which result in
fewer medication errors.

Improved wayfinding
elements, such as color, images, and signage, to better orient patients
and families and help them find their destination. This reduces the
disorientation and resulting stress in patients and families.

A variety of social spaces,
such as lounges and waiting rooms to accommodate various social
functions. Also desirable is comfortable, moveable furniture in small
groupings to facilitate socialization.

What about changes in the relationships with caregivers?

One
of the key factors driving changes in healthcare is the concept of
patient-centered care. In this new approach, patients are treated with
dignity and their needs for privacy and individual expression
respected. Likewise, patients are informed about their clinical status,
progress, and prognosis, and their test results and treatments are
clearly explained.

Patients and their families are seen as
partners in decisions about treatment and care, and their concerns are
addressed. They are offered options including access to complementary
therapies and healing practices.

What are some other changes?

Increasingly
hospitals and other healthcare facilities are offering an integrative
care approach, where complementary therapies are available to help
patients cope with the effects of their disease or condition.

For
example, Woodwinds Hospital in Minnesota offers massages to women in
labor to promote relaxation. At Abbott Northwestern Hospital in
Minneapolis, nurses use guided imagery[16] with patients before surgery to
reduce emotional symptoms such as anxiety and fear, and physical
symptoms such as rapid breathing, rapid heart rate, and high blood
pressure. At North Hawaii hospital, nurses offer Healing Touch both
before and after surgery.

Another
beneficial change is a renewed recognition of the importance of
nutrition. Planetree hospitals offer patients a menu that they can
order from when they are hungry, and the healthy, tasty food is cooked
to order (as opposed to hospital meals delivered at set times).